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South Dakota rates for HCPCS L3702

Elbow orthosis (EO), without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $218.78 / $218.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $177.83 / $269.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $181.97 / $354.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $363.08 / $457.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $323.59 / $602.56
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $199.53 / $1,584.89
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $346.74 / $346.74
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.81 / $354.81 / $354.81
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $288.40 / $575.44
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $323.59 / $426.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $158.49 / $338.84
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $302.00 / $302.00